Application Form

This document pretains to ITC-STA-20120908-00219 for Special Temporal Authority on a International Telecommunications filing.

INTERNATIONAL SECTION 214 SPECIAL TEMPORARY AUTHORITY APPLICATION FCC FORM 214STA FOR OFFICIAL USE ONLY

APPLICANT INFORMATION

Enter a description of this application to identify it on the main menu:

ASLI seeks 6-month extension of prior STA in File No. ITC-STA-20120313-00074.

1. Applicant Name: American Samoa License, Inc. Phone Number: 684-699-2759 DBA Name: Fax Number: 684-699-6593 Street: 478 Lafou Shopping Center E-Mail: [email protected] P.O. Box 478 City: Pago Pago State: AS Country: USA Zipcode: 97699 -0478 Attention: Mr Adolfo Montenegro

2. Contact Name: Kent D. Bressie Phone Number: 202-730-1337 Company: Wiltshire & Grannis LLP Fax Number: 202-730-1301 Street: 1200 18th Street, N.W. E-Mail: [email protected] Suite 1200 City: Washington State: DC Country: USA Zipcode: 20036 -2516 Contact Title: Relationship: Legal Counsel

3. Place of Incorporation of ApplicantAmerican Samoa

4. Other Company(ies) and Place(s) of Incorporation

5. Service Type(s) (check all that apply) Global or Limited Global Facilities-Based Authority (Section 63.18(e)(1)) Global or Limited Global Resale Authority (Section 63.18(e)(2)) Individual Facilities-Based Service (Section 63.18(e)(3)) Individual Switched Resale Service (Section 63.18(e)(3)) Individual Facilities-Based and Resale Service (Section 63.18(e)(3)) Switched Services over Private Lines (ISR) (Section 63.16 and/or 63.18 (e)(3)) Inmarsat and Mobile Satellite Service (Section 63.18(e)(3)) Overseas Cable Construction (Section 63.18(e)(3)) Individual Non-Interconnected Private Line Resale Service (Section 63.18(e)(3)) Other (Section 63.18(e)(3))

TYPE OF REQUEST 6. New Request Extend STA Date Other 7. Date Authorization Needed:09/18/2012

8. Is a fee submitted with this application? If Yes, complete and attach FCC Form 159. If No, indicate reason for fee exemption (see 47 C.F.R.Section 1.1114). Governmental Entity Noncommercial educational licensee Other(please explain):

9. Description of Special Temporary Authority Requested. ASLI seeks 6-month extension of prior STA in File No. ITC-STA-20120313-00074.

10. In Attachment 1, provide justification of need for special temporary authority requested.

11. If this request for Special Temporary Authority is associated with any pending applications filed with the Commission, enter either the file number [e.g., ITC-214-19930101-23412] or the IB Submission ID of the pending application [e.g., IB200311111] AND go to question 16.) File Number ITCSTA2012031300074 or Submission ID

Applicant certifies that its responses to questions 11 through 17 are true:

12. If the applicant is a foreign carrier, or is affiliated (as defined in 47 C.F.R. Section 63.09(e)) with a foreign carrier, provide in Attachment 1 the information and certifications required by Section 63.18(i) through (m).

13. Does the applicant seek authority to provide service to any destination described in paragraphs (1) through (4) of Section 63.18(j)? If yes, list those destinations in Attachment 1 as a response to question 12. Yes No

14. Does the applicant seek authority to provide service to any destinations other than those listed in response to question 12 where it has an affiliation with a foreign carrier? If yes, list those destinations in Attachment 1 as a response to question 13. Yes No

15. [Section 63.18(h)] In Attachment 2, provide the name, address, citizenship and principal business of the applicant's ten percent or greater direct and indirect shareholders or other equity holders, and identify any interlocking directorates.

16. In Attachment 1, respond to paragraphs (d), (e)(3) and (g) of Section 63.18.

17. By checking Yes, the undersigned certifies that neither applicant nor any other party to the application is subject to a denial of Federal benefits that includes FCC benefits pursuant to Section 5301 of the Anti-Drug Act of 1988, 21 U.S.C. Section 862, because of a conviction for possession or distribution of a controlled substance. See 47 CFR 1.2002(b) for the meaning of "party to the application" for these purposes. Yes No

18. By checking Yes, the applicant certifies that it has not agreed to accept special concessions directly or indirectly from a foreign carrier with respect to any U.S. international route where the foreign carrier possesses sufficient market power on the foreign end of the route to affect competition adversely in the U.S. market and will not enter into such agreements in the future. Yes No

CERTIFICATION

19. Typed Name of Person Signing Adolfo Montenegro	20. Title of Person Signing President
WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE PUNISHABLE BY FINE AND / OR IMPRISONMENT (U.S. Code, Title 18, Section 1001), AND/OR REVOCATION OF ANY STATION AUTHORIZATION (U.S. Code, Title 47, Section 312(a)(1)), AND/OR FORFEITURE (U.S. Code, Title 47, Section 503).
21. 1: Extension Request 2: Attachment 1 3: Attachment 2

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT The public reporting for this collection of information is estimated to average 8 hours per response, i ncluding the time for reviewing instructions, searching existing data sources, gathering and maintaining the re quired data, and completing and reviewing the collection of information. If you have any comments on this burd en estimate, or how we can improve the collection and reduce the burden it causes you, please write to the Fede ral Communications Commission, AMD-PERM, Paperwork Reduction Project (3060-0686), Washington, DC 20554. We wil l also accept your comments regarding the Paperwork Reduction Act aspects of this collection via the Internet i f you send them to [email protected]. PLEASE DO NOT SEND YOUR RESPONSE TO THIS ADDRESS. Remember - You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number or if we fail to provide you with this notice. This collection has been assigned an OMB control numbe r of 3060-0686. THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1 995, 44 U.S.C. SECTION 3507.